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Bone Grafting: Know the Facts

Bone grafting is used in oral surgery when the amount of bone in a patient’s jaw is insufficient or too soft to support traditional dental implants. It lays the foundation—by adding or “growing” new bone—so that dental implants can be placed for restorative solutions, such as crowns, bridges, or a full set of non-removable (screwed in) teeth. Bone grafting is typically a minor procedure that can be done on an outpatient basis in the surgeon’s office under local anesthetic or sedation.

At Bergen Oral & Maxillofacial Surgery (BOMS), we have the experience and the expertise to determine the best course of action and provide the right surgical approach for each bone graft patient. Every patient is different, so we begin with a thorough oral examination, including panoramic x-rays and a 3Dimensional CAT scan to evaluate the overall condition of the affected teeth, gums and jaw.

Why Bone Grafting May Be Needed

The loss of bone density in the jaw area most often occurs over time when the jawbone begins to “resorb” or atrophy after a tooth is extracted, lost or extremely damaged. Typically, there are three major factors that can precipitate an insufficient amount of jaw bone volume: periodontal (gum) disease, tooth extractions, major injuries, and infections or disease.

Periodontal disease, when left untreated, can erode and damage the jawbone that supports the teeth. Ultimately, teeth become loosened and unstable. Tooth extractions generally result in a 40-50% loss of bone in the surrounding area within three years of the surgery. The jawbone can also recede or erode as the result of injuries to the jaw, serious infections such as untreated gingivitis, and the presence of major disease or tumors.

The resulting tooth defects may require a bone graft before new teeth can be successfully implanted.

What Bone Grafting Involves

Before we begin, the BOMS team will identify the best source for new bone tissue to be transplanted (grafted) to the affected jaw area. In an autogenous graft, new bone can be obtained from the patient’s own jaw, but more commonly the source is treated human cadaver bone (see below). To replace bone in the back of the upper jaw, we frequently perform sinus bone grafts—addition of bone beneath the sinus to add additional bone height for dental implant placement.

We can also procure bone from a bone tissue bank. Tissue banks store bone tissue from several medically approved sources, including cadaver or synthetic bone (allografts) and bovine bone (xenografts). A new alternative is the injection of bone morphogenetic proteins (BMPs) that help to promote new bone growth. This approach has been used successfully in spine and orthopedic surgery and has the ability to generate new bone at an amazing rate.

For major bone grafts, typically resulting from traumatic injuries, tumor surgery or congenital defects, the bar is raised. Repairs are made using the patient’s own bone, generally from the skull (cranium), hip (iliac crest or lateral knee (tibia). That is why these patients require hospital care.

Regardless of the source, our surgeons proceed with a small incision to prepare the site before the graft is added and anchored in place. We may also apply special synthetic membranes that dissolve under the gums to protect the bone graft and encourage bone regeneration (known as guided bone regeneration or guided tissue regeneration).

How to Navigate through Recovery

Regardless of the complexity of the surgery, successful bone grafting can take several months to complete. We are, in effect, combining or fusing new and different bone to the body, and it takes time for bone cells to migrate and permanently adhere to a new area before they can ultimately grow.

Every patient leaves BOMS with a list of comprehensive instructions for post-operative care, as well as prescriptions for medication to manage pain, infection and swelling. You’re also given a personal set of protocols for follow-up visits and treatments to complete the post-operative process and monitor your bone growth.

Bone grafts have a high success rate, and in most cases, you will have sufficient new bone growth for restorative measures in a matter of months.

All of us at Bergen Oral & Maxillofacial Surgery (BOMS) are committed to helping our patients navigate their way to full recovery and dental restoration. We’re always here to answer your questions and to give you the best care possible.

For more information bone grafts, contact us at one of our offices: Hackensack: 201.343.8297, Westwood: 201.664.5656, or Ridgewood: 201.444.4137.